Inhaler assessment in COPD patients

Dougall, Shelby; Bolt, Jennifer; Semchuk, William; Winkel, Tanya

doi:10.1177/1715163516660573

Cited by 19 publications

(32 citation statements)

References 13 publications

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“…In addition to the weakness of respiratory muscles, the high prevalence of comorbidities in COPD patients is also considered a big challenge which makes them more likely to have impaired physical skill, manipulation, dexterity, hand strength and/or hand‐lung coordination which is the leading cause of treatment failure with some DPIs 7 . Also, device‐related factors that may affect appropriate administration include the complexity of set‐up, dose preparation and inspiratory capacity required for optimal drug delivery 13,14 . The subject might inhale double the needed amount of the drug if DPI is loaded twice, this could put them at risk of unneeded adverse effects.…”

Section: Introductionmentioning

confidence: 99%

In vitro and in vivo performance modelling and optimisation of different dry powder inhalers: A complementary study of neural networks, genetic algorithms and decision trees

et al. 2020

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Introduction Aerosol delivery from DPIs could be affected by different factors. This study aimed to evaluate and predict the effects of different factors on drug delivery from DPIs. Methods Modelling and optimisation for both in vitro and in vivo data of different DPIs (Diskus, Turbohaler and Aerolizer) were carried out using neural networks associated with genetic algorithms and the results are confirmed using a decision tree (DT) and random forest regressor (RFR). All variables (the type of DPI, inhalation flow, inhalation volume, number of inhalations and type of subject) were coded as numbers before using them in the modelling study. Results The analysis of the in vitro model showed that Turbohaler had the highest emitted dose compared with the Diskus and the Aerolizer. Increasing flow resulted in a gradual increase in the emitted dose. Little differences between the inhalation volumes 2 and 4 litres were shown at fast inhalation flow, and interestingly two inhalations showed somewhat higher emitted doses than one‐inhalation mode with Turbohaler and Diskus at slow inhalation flow. Regarding the in vivo model, the percent of drug delivered to the lung was highly increased with Turbohaler and Diskus in healthy subjects where continuous contour lines were observed. The Turbohaler showed increased lung bioavailability with the two‐inhalation modes, the Diskus showed a nearly constant level at both one and two inhalations at slow inhalation. The Turbohaler and Aerolizer showed little increasing effect moving from one to two inhalations at slow inhalation. Conclusions Modelling of the input data showed a good differentiating and prediction power for both in vitro and in vivo models. The results of the modelling refer to the high efficacy of Diskus followed by Turbohaler for delivering aerosol. With two inhalations, the three DPIs showed an increase in the percent of drug excreted at slow inhalations.

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Section: Introductionmentioning

confidence: 99%

In vitro and in vivo performance modelling and optimisation of different dry powder inhalers: A complementary study of neural networks, genetic algorithms and decision trees

et al. 2020

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“…Recommended strategies for COPD management commonly involve the use of inhaled medication [4]. It has been generally accepted that delivering medications via inhalation would allow for accurate and direct administration of medications to the intended area, while systemic absorption would be reduced, which in turn increases the possibilities of clinical benefit utilization and decreases the risk of potential side effects [5]. However, a number of studies have indicated that such COPD management strategies have not succeeded in providing optimal efficiency, with medication non-adherence and incorrect inhaler technique found in patients being cited as the main reasons [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Inhaler Technique and Adherence to Inhaled Medications among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Vietnam

Ngo

Phan

et al. 2019

IJERPH

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Sub-optimal chronic obstructive pulmonary disease (COPD) management has been found largely due to patients’ medication non-adherence and incorrect inhaler technique. This study aimed to examine inhaler use technique and medication adherence among Vietnamese COPD patients as well as potential associated factors. A cross-sectional study involving 70 COPD exacerbators was conducted. Inhaler technique and adherence were evaluated by the 10-item and 12-item Test of Adherence to Inhaler (TAI). Data on the history of COPD, home prescription of inhalers and duration of hospitalization were also collected. Generalized linear regression models were used to determine the associated factors with inhaler use and medication adherence. The results showed that the proportion of patients with good inhaler technique was 22.7% for metered-dose inhalers (MDI), 30.4% for dry powder inhalers (DPI) and 31.8% for soft-mist inhalers (SMI). Full exhalation was the most common mistake. The rates of non-compliance patterns were: “ignorant” (77.1%), “sporadic” (58.6%), and “deliberate” (55.7%). Worse dyspnea, greater health condition impairment, and an increased frequency of exacerbations and hospitalizations were found to be associated negatively with correct inhaler use and treatment adherence. Instructions to COPD patients about using inhalers should focus on correct inhaler technique and adherence even when feeling healthy.

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“…Ease of use is particularly important for patients with COPD, many of whom are elderly and have manual dexterity issues, cognitive impairment, or co-morbidities [45]. As described earlier, many patients with COPD have difficulty obtaining the required inspiratory flow rate to achieve effective drug delivery with DPIs, and peak inspiratory flow rate decreases with age and worsening disease severity [31].…”

Section: Patient Perspectivesmentioning

confidence: 99%

“…Older age has also been shown to be associated with worsening inhaler technique [46]. In this respect, the Respimat SMI has many features that are useful for older patients, including the simplicity of preparing a dose, the ability to obtain drug delivery at low inspiratory flow rates, and the fact that minimal manual dexterity is required to initiate administration [41, 45]. Possible disadvantages of the Respimat SMI are that the device needs some basic assembly and priming before the first use [6], and tends to cost more than older inhalers, which can be a consideration for some patients [43].…”

Section: Patient Perspectivesmentioning

confidence: 99%

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The Respimat® Soft Mist Inhaler: Implications of Drug Delivery Characteristics for Patients

et al. 2019

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Successful treatment for respiratory diseases relies on effective delivery of medication to the lungs using an inhalation device. Different inhalers have distinct characteristics affecting drug administration and patient adherence, which can impact clinical outcomes. We report on the development of the Respimat® soft mist inhaler (SMI) and compare key attributes with metered-dose inhalers (MDIs) and dry powder inhalers (DPIs). The Respimat SMI, a pocket-sized device generating a single-breath, inhalable aerosol, was designed to enhance drug delivery to the lungs, reduce the requirements for patient coordination and inspiratory effort, and improve the patients’ experience and ease of use. The drug deposition profile with Respimat SMI is favorable compared with MDIs and DPIs, with higher drug deposition to the lung and peripheral airways. The slow velocity and long spray duration of the Respimat SMI aerosol also aid patient coordination. Clinical equivalence has been demonstrated for maintenance treatment of chronic obstructive pulmonary disease using once-daily tiotropium between Respimat SMI (5 µg) and HandiHaler DPI (18 µg). In comparative studies, patients preferred Respimat SMI to MDIs and DPIs; they reported that Respimat SMI was easy to use and felt the inhaled dose was delivered. The Respimat SMI, designed to generate a slow-moving and fine mist, is easy to use and effectively delivers drug treatment to the lungs. The patient-centered design of Respimat SMI improved patient satisfaction, and may help to promote long-term adherence and improve clinical outcomes with asthma and chronic obstructive pulmonary disease.

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Inhaler assessment in COPD patients

Cited by 19 publications

References 13 publications

In vitro and in vivo performance modelling and optimisation of different dry powder inhalers: A complementary study of neural networks, genetic algorithms and decision trees

In vitro and in vivo performance modelling and optimisation of different dry powder inhalers: A complementary study of neural networks, genetic algorithms and decision trees

Inhaler Technique and Adherence to Inhaled Medications among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Vietnam

The Respimat® Soft Mist Inhaler: Implications of Drug Delivery Characteristics for Patients

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